Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3275 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
TCM -T1017TL TARGETED CASE MANAGEMENT 41 42 27.114284 $1008.6400 $37.2000
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Subtotal (Total Children Is Unduplicated) 41 42 27.114284 $1008.6400 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 11 11.000000 $498.5200 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 11 15 4.561114 $265.0600 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 20 20 12.444447 $723.1600 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 14 19 7.927780 $460.7000 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 12.005556 $697.6500 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 25 29 14.083338 $818.4100 $58.1100
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Subtotal (Total Children Is Unduplicated) 61 105 64.022235 $3579.7200 $55.9100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.155556 $7.7800 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 365 412 477.758703 $23887.8100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 48 92.761113 $4638.0500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 572 656 547.459489 $27372.8100 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 92 193 941.571431 $25422.4200 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1034 1296 12279.711905 $663104.4800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 9.142857 $493.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 89 184 485.499996 $39480.8700 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 64 123 347.642854 $28270.3300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 2 26.000000 $1693.1200 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 92 185 448.280949 $36454.2000 $81.3200
TRAV -TRAVS Travel by mile 20 27 203.760317 $90.6700 $0.4500
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Subtotal (Total Children Is Unduplicated) 1125 3128 15859.745170 $850916.2400 $53.6500
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Total 3275 15950.881689 $855504.6000 $53.6300
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Number of Children (Unduplicated) With at Least One Authorization 1150